ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. 2022, Journal of Parenteral and Enteral Nutrition, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Halse C, Broughtwood D, Clarke S, Honey A, Kohn M, Madden S. Illumating multiple perspectives: meaning of nasogastric feeding in anorexia nervosa. The findings of this systematic review suggested that specific subgroups of population, such as inpatients from ICU and those initially supplied with higher caloric intakes, might have an increased risk for RFS/RH, but robust evidence is still lacking. Fabrizio Pasanisi: Visualization, Writing - Review & Editing. Strik Lievers L, Curt F, Wallier J, Perdereau F, Rein Z, Jeammet P, et al. https://doi.org/10.1007/s40519-018-0572-4. Refeeding syndrome can affect anyone. Careers, Unable to load your collection due to an error. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? Extended period NPO (>5 days). Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. Parker E, Faruquie S, Anderson G, et al. The results of this review support the conclusions from Rizzo and colleagues [49] (2019) that NG feeds can be safely administered and have the advantage of shortening LOS when used to increase total caloric intake. 2 of these studies [24, 26] for the first 2472h started with continuous NG feeding, using higher than standard calorie protocols, 24003000kcal per day prevented any initial drop in weight. Any discussion on the risks of the refeeding syndrome should include the increased threat of infection that may often be silent in malnutrition. Journal of Eating Disorders Correspondence to Anorexia Nervosa in the Acute Hospitalization Setting Glycaemic control (GC) may improve outcomes, though safe and effective control has proven elusive. DOI: Khan LUR, et al. Clinical adaptations/cohorts include variations on upper target (UL-9 with 9.0mmol/L, reducing workload and nutrition responsiveness), and insulin only (IO) with clinically set nutrition at 3 glucose concentrations (71g/L vs. 120 and 180g/L in the TARGET study). Kezelman S, Crosby RD, Rhodes P, Hunt C, Anderson G, Clarke S, et al. Inclusion in an NLM database does not imply endorsement of, or agreement with, Gusella JL, Campbell AG, Lalji K. A shift to placing parents in charge: does it improve weight gain in youth with anorexia? Table1 includes a summary of included studies. 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. National Institute for Health and Clinical Excellence. official website and that any information you provide is encrypted Neiderman et al [40] qualitative study describes patients time receiving NG varying from 1 to 476days (methods not explained). Two studies examined therapeutic interventions to reduce the need for NG or length of time on it in medically stable YP [29, 41]. A systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000 to 2020. No study reported a YP developed RS. Article Retrospective cohort analysis of 5 glycaemic control cohorts spanning 4 years (n=273) from Christchurch Hospital Intensive Care Unit (ICU). PubMed, Embase, Cochrane Library, Web of Knowledge, and two Chinese databases were systematically searched until October 2021. CF performed the discussion. A systematic review of the published literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15]. PLT was based on FBT and included parents reducing child exercise and increasing oral intake. 2019;9(10):e027339. Cookies policy. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Intravenous (IV) infusions based on body weight are often used to replace electrolytes. statement and The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI). Ann Intern Med. The most common primary disease was cancer (n=267), followed by mesenteric ischemia (n=104), and surgical complications (n=62). https://doi.org/10.5694/j.1326-5377.2009.tb02487.x. Refeeding may take up to 10 days, with monitoring afterward. This review aims to assess strategies for the use, tolerance and effectiveness of NG feeding in YP with restrictive ED. Provided by the Springer Nature SharedIt content-sharing initiative. Most patients (96%) however present less severely with serum hypophosphataemia and no clinical signs [19]. The majority of studies included were retrospective and based around case note reviews which are subjective and therefore likely to be biased. Hay AP, Chinn D, Forbes D, Madden S, Newton R, et al. NICE. Refeeding Syndrome Results have shown that NG feeding is used commonly in the hospital setting to treat medical instability as a result of severe malnourishment, and in the specialist eating disorders (ED) unit due to failure to meet oral intake. ASPEN Consensus Recommendations for Refeeding Syndrome JM was responsible for references and editing. Prevention is critical in avoiding the life-threatening complications of refeeding syndrome. Google Scholar. Until a consensus definition is obtained, the following criteria seems reasonable: (29901461). clos Nutritional care pathway (NICE, 2006, BAPEN, 2007) Screen for malnutrition (using MUST screening tool) refeeding syndrome: 25-35 kcal/kg/day total energy INCLUDING that derived from protein 0.8 In some cases, refeeding syndrome can be fatal. 2017;31(45):427. A secondary care hospital in rural India serving a highly tuberculosis (TB) and malnutrition endemic region. You may be at risk if one or more of the following statements apply to you: You may also be at risk if two or more of the following statements apply to you: If you fit these criteria, you should seek emergency medical care immediately. Terms and Conditions, WebRefeedingSyndromeDefinitionandBackground. Before Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. See additional information. Int J Eat Disord. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. The studies were analysed for risk of bias independently by CF, KH and JM. The reintroduction of enteral or parenteral nutrition, leading to refeeding hypophosphatemia (RFH), has been presented as potential risk factor. All rights reserved. RS can manifest as hypophosphatemia (HP), hypomagnesemia, hypokalemia and other electrolyte imbalances that result in cardiac arrhythmias, seizures and in some cases sudden death [18]. References were exported and duplicates were removed using the title and abstract. A team with experience in gastroenterology and dietetics should oversee treatment. A blood test that reveals low levels of phosphorus, potassium or magnesium. Turk J Pediatr. Figure1 displaying PRISMA flowchart of methodology utilised to search databases for this systematic review of enteral feeding in young people with restrictive eating disorders. Kwashiorkor and Marasmus: Whats the Difference? J Adolesc Health. Disordered eating is often misunderstood. The risk of bias was deemed to be medium or high (see Additional file 1: Appendix 2) for the majority of the studies included due to the nature of their design, being case series or retrospective cohort studies. Previous studies indicate that the incidence of refeeding syndrome is relatively high [12], including electrolyte abnormalities with sodium-water retention, which may potentially lead to heart and respiratory failure, even death [11,13,14]. It is evident that there is a wide variety of practices regarding implementation and regime of NG feeding in YP with eating disorders globally [9]. Other metabolic changes can also occur. By using this website, you agree to our Dysphagia or hyperemesis. Death is often caused by cardiac abnormalities associated with extremely low bodyweight [6]. Hypophosphatemia during critical illness has been associated with adverse outcome. These studies discussed ceasing NG feeds after the risk of RS had reduced; most gave a time frame between 2 and 14days [24, 44]. Petkova BH, Simic M, Nicholls D, Ford T, Prina AM, Stuart R. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. Springer Nature. J Eat Disord. This lack of evidence was confirmed by another systematic review and meta-analysis published in 2021. Changes in these symptoms were not attributed to the rate of weight restoration suggesting a rapid refeeding schedule would not exacerbate psychiatric symptoms. Int J Mental Health Nursing. This has resulted in a variety of NG feeding practices across different settings, with many medical wards tending to provide continuous NG feeds and cease oral intake in order to medically stabilise the patient [20, 22,23,24,25,26]; in contrast mental health wards or specialized eating disorder programs housed on medical wards may be more likely to use syringe bolus feeds to provide food when meals are refused, encouraging oral intake and aiding normalisation of eating [9, 18, 27,28,29,30,31]. Andrea Evangelista: Formal analysis; Software. When carbohydrate consumption is significantly reduced, insulin secretion slows. Depending on the severity of psychiatric and medical symptoms, patients may be admitted to a mental health or medical ward. People who are at risk of heart-related complications may require heart monitoring. Some studies have demonstrated that the bioavailability of oral thiamine is substantial. Glucose intolerance and insulin resistance manifest as hyperglycaemia in intensive care, which is associated with mortality and morbidities. A blood test has revealed your serum phosphate, potassium, or magnesium levels are low. Gusella and colleagues [41] compared parent led therapy (PLT) to non-specific therapy (psychologist led talking therapy). Arch Dis Child. 2000;28(4):4705. < 40%. The present study showed that the incidence of RFS is highly dependent on the definition used and the population analyzed, ranging from 0% up to 62%. Hindley, K., Fenton, C. & McIntosh, J. In two studies intensive meal support and concurrent therapy reduced the number of NG episodes (in medically stable YP) before managing a full oral diet [29, 41]. Increasing awareness and using screening programs to identify those at risk of developing refeeding syndrome are the next steps in improving the outlook. The incidence of RFS is at present uncertain due to heterogeneity of subjects involved and the lack of a universally accepted definition [3,4,7]. Refeeding Syndrome Guideline This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidan Cite this article. This site represents our opinions only. WebThese consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. Perhaps carbohydrates should initially be limited to <40% of the total energy intake. J Eat Disord. NG feeding may be administered through different methods such as continuously, multiple single meals (bolus), or overnight to supplement day-time oral intake. Conversely, in MH wards, if NG has to be given under restraint, it may be required for a significant duration; in one study [46] the average was 170days. 1 Malnourished National Library of Medicine Clausen [46] described NG as the most frequently used involuntary measure in psychiatric practice and is most commonly used in 1517year olds. Refeeding syndrome is a serious and potentially fatal complication of nutritional rehabilitation in patients with severe anorexia nervosa. Different methods of NG may be utilised safely, with NG feeds often given as large bolus, continuously through a pump or overnight in order to supplement daytime oral intake [12, 13]. If you're underweight and looking to gain weight, it's very important to do it right. Iolanda Cioffi: Conceptualization, Data curation, Methodology, Writing- Original draft preparation, Writing - Review & Editing. Psychiatric nursing assistants views centred around: NG being an unpleasant practice, becoming sensitized or desensitized, and the importance of developing coping mechanisms to manage the distress. To analyze the relationship of lengths of stay to muscle parameters, the competing risk approach introduced by Fine and Gray was applied. incidence of the refeeding syndrome. A systematic Restore circulatory volume and monitor fluid balance and overall clinical status closely. The average length of time on NG feeding in this study was 20.7days; NG was terminated as YP accepted more than 50% oral caloric quota compared to theoretical reported quota. NOTE: Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). RH was found in 37% (10/27). A major cause of refeeding syndrome seems to be an endogenous insulin surge, which is triggered by carbohydrate intake. https://doi.org/10.1155/2016/5168978. Fabio Bioletto: Data curation, Writing - Review & Editing. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. Early RFH was defined as serum/plasma phosphate <0.65mmol/L and a drop of >0.16mmol/L within 3 days of admission to the PICU. A history of alcoholism or misuse of certain drugs, such as insulin, chemotherapy drugs, diuretics or antacids. A new riskassessment model was developed; nevertheless, further validation In patients experiencing refeeding syndrome, a dangerous shift in fluids and electrolytes occurs within the body, resulting in compromised cardiovascular status, respiratory failure, seizures and even death. Advance diet gradually as tolerated. 2019;34(3):35970. specialist registrar gastroenterology and clinical nutrition. Int J Eat Disord. Refeeding syndrome is caused by sudden shifts in the electrolytes that help your body metabolize food. https://doi.org/10.1016/j.encep.2012.06.001. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. There were no studies from Asia, South America or Africa. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. 2013;53(5):5904. Bethesda, MD 20894, Web Policies We investigated the occurrence of early RFH, its association with clinical outcome, and the impact of early parenteral nutrition (PN) on the development of early RFH in pediatric critical illness. This exploratory study is based on the data from the Supplemental Parenteral Nutrition study 2 (SPN2), which measured EGP and GNG at days 4 and 10 in 23 critically ill patients. Treatment usually involves replacing essential electrolytes and slowing down the refeeding process. (2011). 2023 Healthline Media LLC. Check electrolytes (including magnesium and phosphate), with aggressive repletion as needed. Research on NG feeding in YP has tended to focus on the acute refeeding phase in paediatric or psychiatric wards to reduce the risk of RS [17]. Enteral nutrition via nasogastric tube for refeeding patients with anorexia nervosa: a systematic review. Bri J Mental Health Nursing. In addition, refeeding often occurs alongside other serious conditions that typically require simultaneous treatment. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. 2005;38(2):1436. (2014). Refeeding is the process of reintroducing food after malnourishment or starvation. In Australian based studies, NG was given due to refusal of oral intake in 2 studies [9, 10] as well as to treat medical instability [26]. In a recent systematic review [32] 9/10 studies in hospitalised ED patients are given continuous or overnight supplemental NG feeding. Eating Disorders: Recognition and Treatment. 2006;163(7):454. Key studies were manually reviewed for additional research, but none were identified that were not already included, 1 eligible study was identified through peer review. Regulation of endogenous glucose production (EGP) is essential for glucose homeostasis. FOIA Results imply modulation of nutrition alongside insulin improves GC, particularly in patients with persistent hyperglycaemia/low glucose tolerance. Couturier J, Mahmood A. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436876/. Refeeding Syndrome: Problems with Definition and Management. The author(s) read and approved the final manuscript. It should be recognized that refeeding syndrome can occur among stressed ICU patients if nutrition is interrupted for only a short period of time (e.g., one week). Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. 2009;190(8):4104. We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM. Pragmatic, prospective studies that control for this confounder are required for any such comparison to be made. volume9, Articlenumber:90 (2021) Butyric acid levels also correlated with several clinical/echocardiographic factors in DCM patients. Prior to 2017, St Georges Hospitals refeeding guidelines (Figure 2/Figure 3) were not in line with NICE's Nutrition Support for Adults guidelines (CG32). This audit included patients from January November 2017 whereby 51 patients were identified as high risk or extremely high risk and 3 were classed as at risk. Int J Eat Disord. In this study the mean LOS was significantly increased: 117days for YP managing oral intake compared to 180days for those requiring NG. The above became the aim of this study. 2016;2016:19. Later, diagnostic criteria and algorithms for the RFS diagnosis based on both electrolyte abnormalities and clinical manifestations have been proposed [5,10,11]. The novel associations between plasma butyric acid levels and HIF3A intron 1 methylation at CpG 6 may highlight an underlying mechanism by which the microbial-myocardial axis and hostmicrobe interactions may participate in the pathogenesis of DCM. The authors found a similarly large variability of the incidence for RFS (062%) as Friedli et al. Refeeding This could have the advantage of reducing LOS in medically stable YP. The National Institute for Clinical Excellence has produced guidance for providing nutrition recommending a graded approach [15]. The https:// ensures that you are connecting to the https://doi.org/10.1002/ncp.10187. sharing sensitive information, make sure youre on a federal https://doi.org/10.1016/j.jadohealth.2009.11.207. Clinical Nutrition (2002) 21 (6): 515-520. 2009;18(2):7584. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18years. Eur Eat Disord Rev. However, this new definition may be insufficiently specific for clinically relevent electrolyte changes and requires clinical validation. This definition is somewhat unique in its incorporation of potassium and magnesium changes. https://doi.org/10.1136/archdischild-2016-310506. Reduce the caloric intake to 20 kCal/hr for at least two days. There are clear risk factors for refeeding syndrome. In this study conducted on patients with chronic protein energy malnutrition (PEM) and TB, we sought to compare nurse-estimated vs. smartphone photograph analytic methods for assessing caloric intake and determine the incidence of refeeding hypophosphatemia (RH) and refeeding syndrome (RFS) in patients with TB. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. the refeeding syndrome. A systematic In 2006, the National Institute for Health and Clinical Excellence (NICE) published a risk-assessment tool for the definition of the RFS risk [9]. DOI: Lambers WM, et al. 2019. Terms & Conditions | Privacy Policy, Read recovery stories from ACUTE patients, See the latest research about conditions treated at ACUTE, Refeeding Syndrome Symptoms and Warning Signs, The Impact of Food Restriction on the Body, Endocrine Dysfunction in Anorexia Nervosa Patients, Complications from the Misuse of Laxatives and Diuretics, Avoidant Restrictive Food Intake Disorder (ARFID). Manage cookies/Do not sell my data we use in the preference centre. We use cookies to help provide and enhance our service and tailor content and ads. The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. All selected studies had an observational design, 23 were retrospective cohort studies [. 2019;115(12):501. A review conducted by Rizzo and colleagues [49] (2019), which focused on NG for acute refeeding, also found a wide variety of practices. Between admission and discharge, Parker et al [24] reported a mean overall weight gain of 7.4kgs, Kezelman 2018 [26] reported a mean overall increase of 3.04kg/m2 BMI; Madden et al [25] reported a mean weight gain of 2.79 kgs during medical instability using continuous NG feeding at 2400 kcals per day. https://doi.org/10.7326/0003-4819-102-1-49. As a library, NLM provides access to scientific literature. Sodium (salt) replacement may also be carefully monitored. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. However, this will be the first systematic review on the use of NG feeding specifically in YP with ED. 2010;46(6):57782. It is probable that medical wards primarily manage YP for short periods to stabilise acute physical health deterioration, while MH wards admit relatively medically stable YP and seek primarily to treat psychological ED symptoms that are preventing an adequate oral diet. Estimating its occurrence is certainly the starting point to sensitize health professionals to suspect and promptly recognize the RFS. the contents by NLM or the National Institutes of Health. Mehanna HM, et al. Core interventions in the treatment and management of anorexia Nervosa bulimia Nervosa and related eating disorders. Length of stay was reported in studies from medical and MH ward settings, however, the specific package of treatment YP received in each study was different depending on the country of origin. NG feeding is an important aspect of treatment for YP with ED who are medically unstable and/or unable to manage an adequate oral diet. The pooled effect of higher calorie intake of 1234 patients in 8 studies was WMD=3.04 (95% CI,5.10 to0.99, P=0.003) days. Plasma butyric acid levels and HIF3A mRNA expression in peripheral blood were decreased in DCM patients, whereas 3 CpGs in HIF3A intron 1 (CpG 6, CpG 7 and CpG 11) were highly methylated in DCM patients.
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